13. Demographics
Starting in 2011
10,000 people in the U.S.
have been turning 65 every day
14. Fastest Growing Population, 85+
20,000
19,041
18,000
16,000
14,000 14,198
12,000
10,000
8,745
8,000
6,597
6,000 5,751
4,000 4,240
2,000
0
2000 2010 2020 2030 2040 2050
Projected Number of Americans 85 years and over
15. Older Americans with
Multiple Chronic Conditions
Medicare beneficiaries
with at least one
chronic condition
Nation’s healthcare
spent on treating
patients with
chronic diseases
Source: AARP. ―Beyond 50.09: Chronic Care: A Call to Action for Health Reform.‖ Washington, DC. 2009
17. A short list…
Lack of nursing educational preparation to meet
the demands of our current healthcare system
Practicing clinicians regularly make decisions
on tradition rather than empirical evidence
Chronic, cyclical nursing workforce shortage
Nursing faculty shortage, yet faculty are poorly
compensated
Shortage of doctoral nurses
Education—practice gap
19. The bottom line
High-quality, patient-centered health care for all
will require remodeling of health care system
Three national healthcare goals (Donald Berwick)
Improve health
Enhance the patient experience
Reduce/contain costs
Nurses are essential partners in achieving
success
20. The challenges before
us require significant
improvement in public
and institutional policies
at national, state and
local levels.
22. Patient Protection and Affordable Care Act 2010
Health Insurance Reform
• Expand insurance coverage
• Expand consumer protections
• Reform industry practices
Status Quo
• Health costs
exceed general
inflation
• Sub-optimal
population health
• Unexplained Payment Reform,
variations in Delivery Systems
practice patterns • Evolve Medicare payment
• Questions about systems from fee-for-service
evidence base of to value based payment
some procedures • Test new payment methodologies
and patient care delivery models
for Medicare, Medicaid & CHIP
Source: Health Solutions Division,
Manatt, Phelps & Phillips, LLP
23. Payment Reform, Quality, and Delivery
System Change Timeline
2010 2011 2012 2013 2015
Shared Savings/
Dual New National pilot:
Accountable Reduced
Eligibles Center, Medic Bundled
Health payment for
Office are & Payments for
Organizations hospital-
established Medicaid Hospital &
(ACOs) acquired
Innovations post-acute care
(FCHCO) conditions
(CMMI) Reduced
payments for
preventable Estimate: these initiatives
hospitalizations will reduce Medicare
Value-based spending by $12b over
purchasing 10 years
for hospitals
Independence
at home
demonstration
project
Source: Kaiser Family Foundation
25. Why Nurses?
A high-quality health
system will provide:
• Chronic care management
• Care coordination
• Prevention and wellness
• Care across the lifespan
Nurses can help
address these needs
26. The Future of Nursing
IOM Report
Ensure that nurses can practice to the
full extent of their education and training
Nurses should achieve higher levels of
education through an improved education
system that promotes seamless academic
progression
27. The Future of Nursing
IOM Report
Nurses should be full partners with
physicians and other healthcare
professionals in redesigning healthcare
in the United States
Improve data collection and information
infrastructure for workforce planning and
policy making
28. 8 Recommendations
Remove scope of practice barriers
Expand opportunities for nurses to
lead and diffuse collaborative
improvement efforts
Implement nurse residency programs
29. 8 Recommendations
Increase proportion of nurses with
BSN degree to 80% by 2020
Double the number of nurses with
a doctorate by 2020
Ensure that nurses engage
in lifelong learning
30. 8 Recommendations
Prepare and enable nurse to lead
change to advance health
Build an infrastructure to collect
and analyze healthcare workforce
data
42. Panelist
Amy Knepp,NP-C,MSN
Chair, Department of Nursing and
Assistant Professor, University of Saint
Francis, Family Nurse Practitioner for
Parkview Physicians Group
47. The Future of Nursing
IOM Report
Ensure that nurses can practice to
the full extent of their education and
training
48. The Future of Nursing
IOM Report
Nurses should achieve higher levels
of education through an improved
education system that promotes
seamless academic progression
49. The Future of Nursing
IOM Report
Nurses should be full partners with
physicians and other healthcare
professionals in redesigning healthcare
in the United States
50. The Future of Nursing
IOM Report
Improve data collection and information
infrastructure for workforce planning
and policy making
53. History
2010 Grant Monies for Development
of Simulation Lab
2011 High Fidelity Simulators-
PediaSim and Metiman
2012 First Simulated Clinical
Experiences (SCE’s) implemented
54. Simulation
Preplanning and Preparation
Identifying Learning Outcomes and
Questions for Students
Simulated Clinical Experience (SCE)
Debriefing
58. Learning Objectives
Demonstrates how to obtain a focused
history of the cardiovascular system using
appropriate communication techniques.
Demonstrates an assessment of the
cardiovascular and peripheral vascular
system
59. Learning Objectives
Recognize normal and abnormal
assessment findings related to the
cardiovascular and peripheral
vascular systems
Identifies modifiable and non-
modifiable risk factors from the history
60. Prep Questions
What data would be significant to obtain a cardiovascular
focused history?
What lifestyle factors affect the cardiovascular and
peripheral vascular systems?
What risk factors are modifiable and which are not?
How is a cardiovascular and peripheral vascular
assessment performed?
61. Prep Questions
What are normal and abnormal pulses related to
the hear and pulses?
How are pulses and pitting edema graded?
What findings would be important to document?
62. Debriefing
Introduction: Discuss faculty role as a
facilitator, expectations, confidentiality, safe
environment for discussion
Personal Reactions: Allow learners to recognize and
release emotions, explore learner reactions
Discussion of Events: Analyze what happened during
the SCE, using video playback if available
Summary: Review what went well and what did
not, identify areas for improvement and evaluate the
experience
Welcome and self introduction by Margaret Stoffregen DeYoungMention the incredible mix of the audience (students, educators, practicing LPNs and nurses and other professionals). What a unique opportunity, nursing profession essential to quality healthcare outcomes. When else has our nursing community had this opportunity to come together/
Mindy YoderThank you to all of our sponsors (name them) Methodist Hospitals, Franciscan Alliance, and Community Healthcare Systems. (USF personnel should start an enthusiastic applause.) After that, you might mention what Franciscan Alliance is…some/most in the audience will not know the name. Thank the Sisters in the audience for joining us today (they can rise and we can applaud).Today’s event is the first in a series of lectures under the “Future of” concept. Periodically, the university will be holding public lectures on substantive topics that we believe benefit our community. The University of Saint Francis is proud to introduce our signature series with the Future of Nursing—which represents a deeper conversation of this vital and dynamic profession in the healthcare field.”
(Mindy continues…name features of today’s program AND the names of the presenters)Future of Nursing by Dr. Mindy Yoder, BSN/MSN Program Director, Department of Nursing. Explain the origin of the study (Robert L. Wood Foundation of Johnson & Johnson fame led ION to commission the study). …we will then dig deeper by looking at the Future of Nursing by asking what Chief Nursing Officers and other experts know about the future of nursing locally and across the state. Panel Discussion moderated by…looking again to the future, we will turn our attention to MetiMan—on stage with us now for a demonstration of how USF student nurses are learning the profession to become future nurses. Simulation Showcase led by Dawn Mabry, Director, School of Health Science Simulation Lab and assisted by a USF student (name nursing student, or let Dawn do that when she is up.)We will wrap up with ….Summary comments by Amy Knepp, Chair, Department of NursingDon’t worry, we will do our best to keep on track today…we’ll even squeeze in a seventh inning stretch to keep us all alert (NG to ad lib this part…).You each should have received a packet that includes a summary evaluation sheet. That is the form you will need to turn in as you exit today. There will be USF students at the doors collecting your evaluations and distributing certificates for two contact hours. I would like to (thank representative’s name?) from Lutheran who helped us facilitate the contract hours certification. Even if you are not collecting contact hours, we would like your feedback on the presentation to prepare for future events.
17% of the GDP is spent on healthcare in the U.S. (as compared with 3-5% in other countries) and is projected to increase to 20% within 7 years (SOURCE: Kaiser Family Foundation based on data from Congressional Budget Office, March 2009); focus on rescue care/sick care vs. preventive care; unnecessary re-hospitalizations allocation of healthcare resources: where are we spending HC dollars?-----healthcare disparities part of being in a democracy is that everyone has a voice and everyone’s opinions differ greatly Care coordination: fragmentation of care, duplication of services, safety/errors Outcomes: Ranked 29th in infant mortality rates by OECD (industrialized countries) Organization for Economic Cooperation and DevelopmentRanked 37th in overall health system performance by WHORanked 24th in D.A.L.Y. (disability adjusted life years)All of this has prompted an urgency for healthcare reform
17% of the GDP is spent on healthcare in the U.S. (as compared with 3-5% in other countries) and is projected to increase to 20% within 7 years (SOURCE: Kaiser Family Foundation based on data from Congressional Budget Office, March 2009); focus on rescue care/sick care vs. preventive care; unnecessary re-hospitalizations allocation of healthcare resources: where are we spending HC dollars?-----healthcare disparities part of being in a democracy is that everyone has a voice and everyone’s opinions differ greatly Care coordination: fragmentation of care, duplication of services, safety/errors Outcomes: Ranked 29th in infant mortality rates by OECD (industrialized countries) Organization for Economic Cooperation and DevelopmentRanked 37th in overall health system performance by WHORanked 24th in D.A.L.Y. (disability adjusted life years)All of this has prompted an urgency for healthcare reform
Per Capita Health Spending And 15-Year Survival For 45-Year-Old Women, United States And 12 Comparison Countries, 1975 And 2005
The 85+ population’s growth rate is 2 times that of those 65+ and almost 4 times that for the total population.As the population ages, the number of dementia cases is projected to more than double, exceeding 11 million by 2050.If this trend continues, how will total health care spending change? Where will dementia patients live? Who will provide care? Who will finance their care?
How will the increasing diversity of the older population change the total prevalence of chronic conditions?What will the impact of increased obesity be on disability rates?Cultural SensitivitiesLifestyle ChangesChronic conditions are the #1 cause of death and disability in the U.S.45% of Americans suffer from at least 1 chronic disease
56 percent of current Indiana nurse educator workforce is projected to retire by 2010 2006 report shows an immediate need to fill 48 vacant positions in Indiana Schools of Nursing Nursing shortage is directly related to schools’ inabilities to expand enrollment due to a shortage of nurse educators. Approximately 1,600 qualified students seeking admission are turned away annually (INWDC annual survey of Indiana nursing programs). http://www.ihaconnect.org/Issues/Workforce/default.aspx (Indiana Hospital Association)
Current economic crisis is keeping nurses in the workforce at presentInter professional collaboration within health care is criticalEducation and practice have different missions
Source: U.S. Health Resources and Services AdministrationProjected shortfall of nurses in 2020= 1 million
Donald Berwick (born 1946) is the outgoing Administrator of the Centers for Medicare & Medicaid Services (CMS), and was formerly President and Chief Executive Officer of the Institute for Healthcare Improvement (IHI)[1] a not-for-profit organization helping to lead the improvement of health care throughout the world. (was appointed as head of CMS in July 2010 by President Obama)
PPACA (A.K.A. Affordable Care Act or “Obamacare”)passed 24 months ago is trying to address these 4 important problems. While the public hears more about the expansion of insurance coverage, the part that will affect providers most is payment reform and testing new delivery systems.CHIP= Children’s Health Insurance Program
These are not far-into-the future changes, they are happening now. With 2012 being an inaugural year for several new initiatives.
Landmark, evidence-based report (600 pages) written by a neutral party– 17 member Board/Commission made up of largely non-nurses, published in October 2010.Report discusses: what does the public need in a transformative, sustainable healthcare system? The answer is: nursing will lead us. Nursing has a holistic view and the mentality that “it is all about the patient”.
Jch/ THIS IS WHAT WE DO!!!!!
KEY MESSAGES-----relate to education,practice, leadership, data and diversityTHE CHALLENGE TO US: Seek significant improvement in public and institutional policies at national, state and local levels URGE audience to read the 8 page summary report (IOM Website) Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement effortsFoster interprofessional collaboration
KEY MESSAGES-----relate to education,practice, leadership, data and diversityTHE CHALLENGE TO US: Seek significant improvement in public and institutional policies at national, state and local levels URGE audience to read the 8 page summary report (IOM Website) Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement effortsFoster interprofessional collaboration
Bullet points not on screen:Identifying the “Right” Measures for Public Reporting and Performance-Based PaymentHHS Aims: measuring what is important to patients and construction of measures specific to patient populations rather than provider settings or diseasesDepartment of Health and Human Services (HHS) Chart illustrates National Quality Strategy Aims and PrioritiesMAPProvide upstream, public-private input to HHS on the selection of performance measures for use in public reporting, performance-based payment, and other programsIdentify gaps for measure development, testing, and endorsementAlign measurement across programs, settings, levels of analysis, populations, and between public and private sector programsPromote coordination of care delivery Reduce data collection burdenMeasure Topics in 5 Areas:Quality of Life: Functional Status Assessment, Health-Related Quality of Life, Palliative Care Care Coordination: Care Transition Experience, Communication with Patient/Caregiver, Communication with Healthcare Providers, Hospital Readmission, Medication ManagementScreening and Assessment: BMI Screening, Falls, Management of Diabetes, Pain ManagementMental Health and Substance Use: Alcohol Screening and Intervention, Depression Screening, Substance Use Treatment, Tobacco CessationStructural Measures: Health IT Infrastructure, Medical Home Adequacy, Medicare / Medicaid CoordinationOther: Patient Experience
Sandie-HELPCredentialsNeed more info
Kimberly J. Harper, MS, RN Executive Director, Indiana Center for Nursing HELPIS this correct??
Sandie-Need infoCredentials.
Amy Knepp NP-C, MSN, RN Chair, Department of Nursing and Assistant Professor, University of Saint Francis. Family Nurse Practitioner for Parkview Physicians Group
KEY MESSAGES-----relate to education,practice, leadership, data and diversityTHE CHALLENGE TO US: Seek significant improvement in public and institutional policies at national, state and local levels URGE audience to read the 8 page summary report (IOM Website) Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement effortsFoster interprofessional collaboration
KEY MESSAGES-----relate to education,practice, leadership, data and diversityTHE CHALLENGE TO US: Seek significant improvement in public and institutional policies at national, state and local levels URGE audience to read the 8 page summary report (IOM Website) Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement effortsFoster interprofessional collaboration
KEY MESSAGES-----relate to education,practice, leadership, data and diversityTHE CHALLENGE TO US: Seek significant improvement in public and institutional policies at national, state and local levels URGE audience to read the 8 page summary report (IOM Website) Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement effortsFoster interprofessional collaboration
KEY MESSAGES-----relate to education,practice, leadership, data and diversityTHE CHALLENGE TO US: Seek significant improvement in public and institutional policies at national, state and local levels URGE audience to read the 8 page summary report (IOM Website) Provide opportunities for nurses to assume leadership positions and to serve as full partners in health care redesign and improvement effortsFoster interprofessional collaboration
